Healthcare Provider Details

I. General information

NPI: 1356930226
Provider Name (Legal Business Name): ANDREA SUGGS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 HIGHWAY 51 S
HERNANDO MS
38632-2634
US

IV. Provider business mailing address

10655 LOBLOLLY ST
OLIVE BRANCH MS
38654-4347
US

V. Phone/Fax

Practice location:
  • Phone: 662-449-1971
  • Fax:
Mailing address:
  • Phone: 901-482-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN878451
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: